Diets for 2019: Best, Better, and Bad

New Year’s 2019 has come and gone, which means some poor souls had a massive amount of terribly soggy confetti to clean up in Times Square; and that US News & World Reportis out with rankings of the best diets for the upcoming year. My condolences to the confetti cleaners, happy New Year wishes to all, and now- let’s talk about those diets.

This year, as each for the past decade or so, I was privileged to serve as one of the judges. For 2019, there were 23 of us, and I must say- the company was quite illustrious. I am delighted to work alongside colleagues I greatly respect, and some very good friends in the mix as well.

The work we did, however, was entirely on our own. The process of ranking the 41 diets represented this year does not involve the expert panel convening and conferring, as it might. Those discussions would be interesting, and as in the movie 12 Angry Men, would almost certainly shift miscellaneous rankings this way, or that. But our process is more like a vote than a verdict.

Each of us receives a well-curated synopsis of each diet from the US News editors running this particular show (a shout-out to Angela Haupt, in particular). Those forms describe and detail the diet in question, its signature features, associated resources (e.g., book, website, etc.), and some of the most relevant, published research. Expert panel members are, of course, expected to know most of this literature already, and in cases of diets we may not know all that well, we are encouraged to search the peer-reviewed literature on our own for additional information.

Each form then presents the same, standard sequence of questions, with multiple choice answers on what is known as a “Likert scale”- generally ranging from something like “not at all” to “entirely.” Questions encompass the expected benefits of the diet for diverse objectives, from lifelong health to short-term weight loss, diabetes prevention/management, to the reduction of cardiovascular risk. We also “score” the diets for nutritional completeness and safety, ease of adoption, and consider the monetary costs involved. Our individual scores are then compiled into the averages across all 23 of us- and the rest, as they say, is history.

You may well know this year’s addition to that history already, since the diet rankings make an inevitable news splash. The news coverage this year has tended to highlight the identification of the Mediterranean diet as best “overall,” meaning for all health and weight goals and for the long term. The DASH diet held this spot for several recent years; last year, DASH and the Medi diet were tied.

To be clear, nothing has happened to make the DASH diet any less good for us this year; and the traditional Mediterranean diet is the same as it ever was. These small shifts are likely due to two factors. First, there have been recent, published studies adding to and fortifying what we already knew about the many advantages of the Mediterranean diet over prevailing, modern diets for the health of people and planet alike. Second, I think my fellow US Newsjudges and I are potentially in the vanguard of a movement we hope will overtake our culture at large: enough with contrived, quick-fix diets predicated on cockamamie rules, elaborate theories, and Draconian restrictions. The Mediterranean diet is not a “diet” at all, but a lifestyle practice, rooted in culture and heritage, sustainable by whole populations across an expanse of not mere weeks- but lifetimes, and generations.

Nearly all of the diets that ranked well in the “overall” category conformed to this theme of balanced, sensible, realistic, and sustainable. The addition of a Nordic diet in the top ten- representing a blend of traditional practices in that part of the world, with an infusion of modern science spanning the past half-century- reflects this consensus. All of the top-scoring diets also represented the same important theme of healthy eating, captured in the pithy insight of Michael Pollan: “food, not too much, mostly plants.”

What of the popular weight-loss diet du jour, the “ketogenic” diet? Well, yes, it ranked high for rapid weight loss. But before you rush out to try it accordingly- it came in spot 38 out of a total of 41 for overall health benefit. As I have pointed out to my patients over the years, a bout of cholera works extremely well for rapid weight loss; that doesn’t make it a good idea! Yes, you can lose weight with the severe restrictions of a keto diet- but you can lose weight you are far more likely to keep off, and find health, too, with any number of wholesome, balanced, sensible diets. The US News rankings reflect the expert consensus on this matter.

If you want to know more about this year’s “best” diets, help yourself to the readily accessible details on the US News site. I will leave the matter of “best” there, and turn my attention now to…better, and bad.

What would make this annual ritual even better? For some years, I have proposed to the US News editors that they should explicitly ask us about each diet: how well would this work for everyone in a family? They have not yet added that question, and here’s hoping they will for next year. We tend to “diet” alone, but “live it” together, and in that unity of lifestyle resides the strength to make it stick. Healthy living is, and really should be, a family affair.

I definitely think it would make the best diet rankings better to ask us: what is the environmental impact of this diet? With our climate and environment in dire peril, it is past time for us all to acknowledge that there are no healthy people on an uninhabitable planet; there are no good diets to choose from when aquifers dry out and crops fail. Diets are only truly “best” if best for people and planet alike. So, editors: please ask us about that next time!

And then finally, what is just plain “bad” about this enterprise? Well, it’s nothing to pin on US News & World Report; rather, the blame here lies with our culture at large. Where diet does the most to promote health and prevent disease; to add years to lives and life to years; and to do so sustainably- nobody is waiting for annual updates about what to eat. Where people eat the “best,” they do so because it is their cultural norm. They eat the way their parents ate, and their parents’ parents, and so on. That our culture blithely runs on Dunkin’, relies on sugar-sweetened beverages for hydration, and markets multi-colored marshmallows as part of a child’s complete breakfast all year- and then awaits diet guidance at New Year’s is, well, dubious at best.

We live in a culture that actively propagates bad eating for profit, a culture that overlooks the quite devastating consequences for adults and children, people and planet alike. And then we compensate with an annual dose of expert guidance. We could, and should, aim much higher than that.

Overall, I like the best diet rankings. But it’s sad and bad that we need them every year. It would be better than best if our culture renounced dieting and quick-fix nonsense, and the predatory profiteering that mortgages the future health of our children. It would be better than best if eating well were not an annual news item, but a cultural practice, all year long.

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Comments (5)

Nina Humphrey

My experience has been count total carbs, not net. Faster weight loss, if that's your goal. The subject of Total vs. Net carbs depends on who you are following. Have to find what works for you. Keto is not a one size fits all. I never bothered about macros, lost 30 lbs. Counted carbs in my head. I had to try things, found nuts stall me....other folks, doesn't affect them. Good luck, all.

Jane Rutter

Lewis Watkin

Stickies

Lovies

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David Katz

Science Guru

David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.

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